COMMUNITY BRIDGES, INC (GLOBE STABILIZATION AND RECOVERY UNIT) - NPI NUMBER 1093960304

Summary

Provider Name: COMMUNITY BRIDGES, INC (GLOBE STABILIZATION AND RECOVERY UNIT)

NPI Number: 1093960304

Clasification: Case Management (251B00000X)

Address:
5734 EAST HOPE DRIVE
SUITE 2
GLOBE, AZ
ZIP 85501

Phone Number: (928) 425-2415



Detailed Information

COMMUNITY BRIDGES, INC is a case management in Globe, AZ. The provider is an organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. The assigned NPI number for this provider is 1093960304 and is registered as an organization entity type.
The provider Is Doing Business As Globe Stabilization And Recovery Unit.

The provider's business address is:

5734 EAST HOPE DRIVE
SUITE 2
GLOBE, AZ
ZIP 85501
Phone: (928) 425-2415
Fax: (928) 425-2464

The provider's authorized official is John F Hogeboom .
The authorized official title is Vp/coo and has the following contact phone number (480) 831-7566.

The enumeration date for this NPI number is 12/1/2008 and was last updated on 9/18/2014.

Map - Location of Practice





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251B00000X Case Management OTC6025 AZ Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 Z145164 OTHER AZ MEDICARE PTAN
2 388723 MEDICAID AZ

NPI Record

No. Field Name Field Value
1 NPI 1093960304
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name COMMUNITY BRIDGES, INC
5 Provider Other Organization Name GLOBE STABILIZATION AND RECOVERY UNIT
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 5734 EAST HOPE DRIVE
8 Provider Second Line Business Practice Location Address SUITE 2
9 Provider Business Practice Location Address City Name GLOBE
10 Provider Business Practice Location Address State Name AZ
11 Provider Business Practice Location Address Postal Code 85501
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 9284252415
14 Provider Business Practice Location Address Fax Number 9284252464
15 Provider Enumeration Date 12/1/2008
16 Last Update Date 9/18/2014
17 Authorized Official Last Name HOGEBOOM
18 Authorized Official First Name JOHN
19 Authorized Official Middle Name F
20 Authorized Official Title or Position VP/COO
21 Authorized Official Telephone Number 4808317566
22 Healthcare Provider Taxonomy Code 1 251B00000X
23 Provider License Number 1 OTC6025
24 Provider License Number State Code 1 AZ
25 Healthcare Provider Primary Taxonomy Switch 1 Y
26 Other Provider Identifier 1 Z145164
27 Other Provider Identifier Type Code 1 01
28 Other Provider Identifier State 1 AZ
29 Other Provider Identifier Issuer 1 MEDICARE PTAN
30 Other Provider Identifier 2 388723
31 Other Provider Identifier Type Code 2 05
32 Other Provider Identifier State 2 AZ
33 Is Organization Subpart Y
34 Parent Organization LBN COMMUNITY BRIDGES, INC
35 Parent Organization TIN
36 Authorized Official Name Prefix Text MR.
37 Authorized Official Credential Text LISAC

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.